Atypical serum immunofixation patterns frequently emerge in immunomodulatory therapy and are associated with a high degree of response in multiple myeloma.
The M-protein is the major reference measure for response in multiple myeloma (MM) and its correct interpretation is key to clinical management. The emergence of oligoclonal banding is recognized as a benign finding in the postautologous stem cell transplantation setting (ASCT) for MM but its significance during non-myeloablative therapy is unknown. In a study of the immunomodulatory combination BiRD, (lenalidomide and dexamethasone with clarithromycin), we frequently detected the emergence of mono- and oligo-clonal immunoglobulins unrelated to the baseline diagnostic M-protein. The new M-proteins seen on serum immunofixation electrophoresis were clearly different in either heavy or light chain component(s) from the original M-spike protein and were termed atypical serum immunofixation patterns (ASIPs). Overall, 24/72 (33%) patients treated with BiRD developed ASIPs. Patients who developed ASIPs compared with patients treated with BiRD without ASIPs, had a significantly greater overall response (100% vs. 85%) and complete response rates (71% vs. 23%). ASIPs were not associated with new clonal plasma cells or other lymphoproliferative processes, and molecular remissions were documented. This is the first time this phenomenon has been seen with regularity in non-myeloablative therapy for MM. Analogous to the ASCT experience, ASIPs do not signal incipient disease progression, but rather herald robust response.
Mark
Tomer
T
Department of Medicine, Division of Hematology and Medical Oncology, Center of Lymphoma and Myeloma, Weill Medical College of Cornell University, New York Presbyterian Hospital-Cornell Medical Center, New York, NY 10021, USA.
Jayabalan
David
D
Coleman
Morton
M
Pearse
Roger N
RN
Wang
Y Lynn
YL
Lent
Richard
R
Christos
Paul J
PJ
Lee
Joong W
JW
Agrawal
Yash P
YP
Matthew
Susan
S
Ely
Scott
S
Mazumdar
Madhu
M
Cesarman
Ethel
E
Leonard
John P
JP
Furman
Richard R
RR
Chen-Kiang
Selina
S
Niesvizky
Ruben
R
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D001856:Bone Marrow Examination; D017291:Clarithromycin / Q000627:therapeutic use; D003907:Dexamethasone / Q000627:therapeutic use; D004359:Drug Therapy, Combination; D005260:Female; D006801:Humans; D007136:Immunoglobulins / Q000097:blood*; D017404:In Situ Hybridization, Fluorescence; D007621:Karyotyping; D000077269:Lenalidomide; D008297:Male; D008875:Middle Aged; D009101:Multiple Myeloma / Q000188:drug therapy* / Q000276:immunology*; D009194:Myeloma Proteins / Q000032:analysis; D011446:Prospective Studies; D013792:Thalidomide / Q000031:analogs & derivatives / Q000627:therapeutic use
D007136:Immunoglobulins; D009194:Myeloma Proteins; C085016:multiple myeloma M-proteins; D013792:Thalidomide; D003907:Dexamethasone; D000077269:Lenalidomide; D017291:Clarithromycin